Grim diagnosis for state

AUSTRALIA'S health expenditure grew at an average 4.9 per cent a year between 2002-03 and 2011-12, according to a Productivity Commission report released last week. Health Minister Peter Dutton said the figures showed why the federal government needed to cut waste for a sustainable health system. JODIE STEPHENS speaks to Tasmanian health figures about why health costs are rising, and what needs to be done.

And the health funding analyst says Tasmanians are particularly vulnerable.

Mr Goddard said the Tasmanian population was older, sicker and poorer than others, making it more dependant on the public health system.

"That's why this is serious," he said.

"If we don't get a lot better as a nation, a lot of people are going to die unavoidably and a disproportionate number of those people will be Tasmanians."

The cost of health is back in the public spotlight after the federal government approved a 6.2 per cent rise in health insurance premiums, and the Commission of Audit received a submission suggesting a $6 patient co- payment on GP visits.

In a report released in November, the Productivity Commission also recommended raising taxes and lifting the pension age to cover increasing health and aged care costs, caused by an ageing population.

But Mr Goddard said an ageing population had little to do with increasing health costs.

"The real drivers have been the cost of drugs, the cost of technology and the constant advent of new and expensive techniques," Mr Goddard said.

Tasmanian Health Organisation North chief executive John Kirwan said rising demand was the key issue at Launceston General Hospital.

Emergency presentations at the LGH increased by 21.6 per cent in the five years to 2013, while raw separations (episodes of admitted patient care) rose 14.7 per cent from 2010 to 2013.

"What we're seeing is just more numbers, higher acuity, and interesting challenges that come from bariatric patients and others," Mr Kirwan said.

"In the past we've managed demand by literally going over budget, but we no longer have that capacity and neither does the state."

Mr Kirwan said he thought it was time for a discussion on what people wanted from the healthcare system, if it was affordable, and who would pay for it - whether it was the state, the Commonwealth, or the patient.

"To some extent if the want and the need isn't matched by the resources ... there needs to be a debate to say, `what do we provide and what don't we provide, or what don't we provide as much of'?"

"Because the demand we get, the complaints about waiting times and others - all valid - but you can only do with what you've got."

Department of Health and Human Services deputy secretary of system purchasing and performance, Michael Pervan, said prevention was key.

Mr Pervan said Tasmanians were presenting to their doctor or an emergency department later in their "disease process" than the rest of Australia, when their conditions were more advanced and treatment was more expensive.

He said the department needed to do a lot more work with Tasmania Medicare Local, GPs and community health services to identify people at risk of deteriorating and keep them healthy.

"The big cost drivers over the next 10 years aren't actually going to come from our workforce or from technology," Mr Pervan said.

"They're going to come from patients ... with complex and chronic conditions, who are on a trajectory now and if we don't change it, will end up staying in hospital for longer and longer periods of time.

"You can't cure things like diabetes ... but you can delay its onset if you get in early enough, and that's the stuff we're not doing effectively as we need to."

But Mr Goddard said diminishing Medicare would compromise quality of life, and he wasn't convinced that prevention policies were effective when they came out of the health budget.

He said the state's hospitals needed to become more efficient, as the cost of treating patients was higher in Tasmania than the rest of the country.

"We should be able to treat at least 15 per cent and probably 20 per cent more people with the same range of conditions - if we got our act together," Mr Goddard said.

"Even when we do that - and I think it is achievable - we still have a hospital system we can't afford to run."

Mr Goddard said only the Commonwealth government could afford hospital costs, with all states in "constant crisis".

"This country can afford a good system, costs are not out of control ... but our way of dealing as a state and a nation is certainly out of control," Mr Goddard said.

"As a nation, we can afford to pay for it, as a state we can't.

"People's lives depend on us getting this right, and people's quality of life - the idea of not only having a life, but having a life worth living."